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After gonorrhea cases spiked during the pandemic in New Brunswick – jumping nearly fivefold between 2020 and 2021, then tripling in the first months of this year compared with last – public health officials took to TikTok, Instagram and dating site Tinder with a cautionary campaign.

“Gonorrhea is on the rise in NB. Pass it on. The message – not gonorrhea,” read the public service announcements, shaded black and yellow like caution tape with a creaky bed audible in the background.

Launched last month, the campaign targeted sexually active people between the ages of 20 and 39 across Fredericton, Moncton and Saint John, where a gonorrhea outbreak that took hold in 2019 among this cohort intensified throughout the pandemic.

“It’s a problem and we’re trying to address it,” said Jennifer Russell, Chief Medical Officer of Health for New Brunswick, which also saw more chlamydia cases this winter.

“Whether it’s a sexual health issue or another health issue, there are many things that have been really overshadowed by COVID-19,” Dr. Russell said. “Now is a good time to address them.”

Public health authorities, sexual-health experts and AIDS advocates are sounding the alarm over rising rates of certain sexually transmitted and blood-borne infections throughout parts of Canada, after testing, treatment and prevention campaigns fell by the wayside during the pandemic. Less detection equates with more spread: With many STIs asymptomatic, more Canadians are unknowingly passing on infections.

“A lot of people expected that we didn’t need to offer STI testing because nobody was going anywhere and having sex. That was just patently untrue. We’re expecting to come out of one pandemic into another really serious situation,” said Natalya Mason, education and outreach co-ordinator at Saskatoon Sexual Health.

Syphilis is multiplying aggressively across much of the country, with surges reported in Saskatchewan, Alberta, British Columbia, Northwest Territories and Ontario, which recorded 2,678 cases last year, the highest number in at least a decade. Gay and bisexual men are the populations most affected by syphilis, according to a B.C. prevention campaign, with several provinces reporting a majority of cases in those 30 to 39 years old.

In Newfoundland and Labrador, more gonorrhea cases were reported in the first three months of this year than for all of 2019, according to figures provided by the Department of Health and Community Services. Several provinces noted evenly divided gender breakdowns for those with gonorrhea and chlamydia, though women are more frequently asymptomatic.

In some regions, HIV is up: Saskatchewan saw a 29-per-cent jump in cases last year compared with 2020, an influx that “partially reflects the impact of the COVID-19 pandemic on risk factors for the disease transmission and access to testing and care,” according to an e-mailed statement from the province’s Ministry of Health.

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Experts are troubled that the latest figures may be an undercount, given how the pandemic limited testing, regular medical care, public health follow-up and data entry. Lab capacity was often overwhelmed with PCR testing, with many of those working in sexual health redeployed to help with COVID-19. More than 45 per cent of services providers that test for STIs described significant decreases in their ability to do so in the pandemic, with 31 per cent halting testing altogether at points in the crisis, according to a national report from the Public Health Agency of Canada.

“The fallout is tremendous. We are seeing it now with increased cases across the country in various STIs,” said Gary Lacasse, Ottawa executive director of the Canadian AIDS Society.

In June 2020, staff at his organization urged then minister of health Patty Hajdu and PHAC to deem sexually transmitted and blood-borne infections testing an essential service nationally (this was not done, Mr. Lacasse said). During a free HIV testing week last November, his group screened about 800 Canadians through self-test kits, rapid tests and blood draws, variously administered through pharmacies, community centres, colleges and universities in all provinces, with some kits also mailed out. Of 213 test results shared with the Canadian AIDS Society through clinics involved in the drive, five were HIV positive, “which is huge,” Mr. Lacasse said.

“Sexual health and STI prevention efforts were clearly hurt during COVID,” said Alex McKay, executive director of the Sex Information & Education Council of Canada, a non-profit organization that focuses on sexual and reproductive health.

Today’s rising rates form part of an upward trend that spans more than two decades, Dr. McKay said. He pointed to large-scale decline in condom use as a major cause: More people are having unprotected sex, he said, because of lowered anxieties about HIV since the advent of prevention medications such as PrEP. Today, HIV is widely viewed as “a chronic infection, not a death sentence,” he added, thanks to anti-retroviral treatments that can make the infection untransmittable.

For decades, the safer sex message focused on preventing HIV, with diseases such as chlamydia and gonorrhea overlooked.

“People have never really paid attention to these other sexually transmitted infections to the extent that they should have been – and they still aren’t today,” Dr. McKay said from Toronto.

During the pandemic, some who chose to have fewer sexual partners or just one partner assumed they were safe and stopped using condoms, he said. This amounted to a false sense of security: “It’s riskier to have unprotected sex with one partner who has an STI than it is to have multiple partners who may have an STI, if you’re using condoms.”

Another factor in the STI rise might be Canadians’ unwillingness to seek help: Of health care providers who focus on sexual health, 66 per cent reported dwindling demand in the first months of the pandemic. Some people felt a kind of double stigma in acknowledging to their primary care providers that they were having unprotected sex and acquiring STIs during lockdowns.

In Saskatchewan, as Ms. Mason’s centre worked to create an engaging syphilis prevention campaign, staff grappled with people’s COVID-19 fatigue – a mounting sense of exhaustion from being constantly on guard about their health.

“How are we going to talk to people about the importance of testing, protection and preventing syphilis infection at a moment when they’re being bombarded with messaging about their health?”

They decided to echo COVID-19 within their syphilis campaign, Mask Up Down There, which stressed both masks and condoms. “It utilized the new health literacy that people have gained through the pandemic” about transmission risk, Ms. Mason said.

In Saskatchewan, preliminary 2021 figures showed 1,749 infectious syphilis cases, up from 397 in 2019. “We saw a 929 per cent increase in syphilis cases over the last five years,” said Ms. Mason, pointing to numbers reported in Saskatoon between 2016 and 2021.

In 2020, the province had the highest new diagnosis rates of HIV in the country, with cases increasing by 29 per cent in 2021 compared with the year prior. This January, the province launched a free, HIV self-test initiative through health centres, pharmacies and community-based organizations.

Experts said it will be crucial for primary care providers to raise this issue with their patients proactively and non-judgmentally, without shaming or scare tactics, which hinder people from seeking out testing and treatment.

“People do feel anxiety, stigma, shame. We need to get past that,” said Brenda Wilson, a public health physician and professor of community health at Memorial University of Newfoundland.

Dr. Wilson served on a national, PHAC-funded taskforce that updated STI screening guidelines to recommend annual testing for chlamydia and gonorrhea for patients under 30 who are sexually active. The two infections often come together, Dr. Wilson said, with chlamydia frequently being asymptomatic. “Even though women often don’t have symptoms, chlamydia nevertheless can cause long-term harm, pelvic inflammatory disease or infertility. It can damage people and they don’t even know they have it.”

Dr. Wilson and other experts believe that the conversation about sexually transmitted infections needs to evolve in Canada. The latest brand of public health messaging positions sexual health as part of sexuality and overall health: People should pay it the same kind of attention they devote to their nutrition, exercise and mental health.

“It is a positive, enjoyable part of our lives,” Dr. McKay said, “and we need to take care of it.”

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